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10/16/2002 15:48 209468; FIFTH FLOOR PAGE 04 <br /> Signature---- ----------------_- ----,- <br /> EH230038 <br /> (revised 1/31/02) <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YE� NO [] <br /> 2. Spec sheets attached for equipment to be installed YES)C NO[] <br /> 3. Description of work to be completed: <br /> 1� A-60vA. Spee ©f ! _ <br /> 4. Description of equipment to be used: <br /> 5. Al equipment is State certified or approved. YES [] NO[] <br /> 6. Desgntamination Procedures: <br /> a. Will pi be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contracto rforming decontamination: <br /> Name_-- --- ----- Phone(___)...—.... <br /> .,.\ <br /> Address City_ ------Zi <br /> 2 <br />